CIGNA’s ERISA sword backfires – ERISA “shining armor” used to protect out-of-network providers as federal district court rules against CIGNA! District Court dismisses all of CIGNA’s Claims and grants out-of-network Humble Surgical Hospital motion in its entirety. On March 24 2015, a federal district court in Houston, Texas ruled against CIGNA and dismissed all of more »

More fallout from the recent Fifth Circuit Court of Appeals decision against Cigna: wide ranging implications for out of network provider reimbursement paradigm on a nationwide scale; 3rd party “re-pricing negotiation” agreements and (Non PPO) discounts would be preempted by ERISA if: “[t]he contracts by their terms are subject to the underlying ERISA plans” In more »

The other shoe drops on insurer’s attempts to limit payments to providers and discourage patient out-of-network utilization based on patient deductibles and co-pays. 5th Circuit decision signals shift towards providers in out of network reimbursement disputes. In a much anticipated second case regarding out-of-network provider’s right to sue and whether coverage may be conditioned on collections of more »

After Resolution Of Contract Negotiations, Is Damage To Members Ignored? ERISA Class Action Filed Over Medical Claim Denials; Alleges Thousands Of Pre-Approved Medical Claims Unpaid, Members Left Holding The Bag; Possibly Delay Ratification Process? On February 26, 2015, just days after the Obama Administration sent in Labor Chief Thomas Perez and a settlement was negotiated between ILWU more »